Incident Rates of Colonic Neoplasia According to Age and Gender: Implications for Surveillance Colonoscopy Intervals (original) (raw)
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Background & Aims Few studies have evaluated long-term outcomes of ongoing colonoscopic screening and surveillance in a screening population. We aimed to determine the 10-year risk for advanced neoplasia (defined as adenomas ≥10mm, adenomas with villous histology or high-grade dysplasia, or colorectal cancer [CRC]) and assessed whether baseline colonoscopy findings were associated with long-term outcomes. Methods We collected data from the Department of Veterans Affairs Cooperative Studies Program Study on 3121 veterans asymptomatic veterans (50-75 years old) who underwent a screening colonoscopy from 1994 through 1997 at 13 medical centers and were then followed for 10 years or until death. We included 1915 subjects with at least 1 surveillance colonoscopy and estimated cumulative incidence of advanced neoplasia Kaplan-Meier curves. We then fit a longitudinal joint model to estimate risk of advanced neoplasia at each subsequent examination, adjusting for multiple colonoscopies within individuals. Results Through 10 years of follow up, there were 146 individuals among all baseline colonoscopy groups found to have at least 1 incident advanced neoplasia. The cumulative 10-year incidence of advanced neoplasia was highest among those with baseline CRC (43.7%; 95% CI, 13.0%-74.4%), followed by those with baseline AA (21.9%; 95% CI, 15.7, 28.1). The cumulative 10-year incidence of advanced neoplasia was 6.3% (95% CI, 4.1%-8.5%) and 4.1% (95% CI, 2.7%-5.4%) for baseline 1-2 adenomas and no neoplasia, respectively (log-rank P=.10). After adjusting for prior surveillance, the risk of advanced neoplasia at each surveillance examination was not significantly increased in veterans with 1 or 2 small adenomas at baseline (odds ratio, 0.96; 95% CI, 0.67-1.41) compared to veterans with no baseline neoplasia. Conclusions Baseline screening colonoscopy findings associate with advanced neoplasia within 10 years. Individuals with only 1 or 2 small adenomas at baseline have a low risk of advanced neoplasia over 10 years. Alternative surveillance strategies, such as the use of non-invasive CRC screening modalities, could be considered for these individuals.
Is Age an Independent Risk Factor for Histopathology of Colorectal Polyps? A Retrospective Analysis
Turkish Journal of Colorectal Disease, 2020
Amaç: Kolorektal kanser ve öncüleri gelişmiş ülkelerde oldukça yaygındır. Sadece sağ taraftaki lezyonların prevalansı için mevcut literatürdeki tahminler, cinsiyet ve ilerleyen yaşla ilişkili olarak %20,5 ile 48,1 arasında değişmektedir. Günümüzde birçok ülkede, poliplerin erken evrede tespit ve tedavi edilebilmesi amacıyla, tarama programlarının yaygınlığını artırıcı çalışmalar yapılmaktadır. Bizde bu yazımızda, hasta yaş ve polip lokalizasyonunun, kolorektal polip histopatolojisi ile ilişkisini değerlendirmeyi amaçladık. Yöntem: Kliniğimizde son 24 ayda 789 hastaya kolonoskopi yapıldı. Bu hastalardan kriterlere uyan 724'ü çalışma grubuna dahil edildi. Hastaların klinik ve poliplerin histopatolojik verileri değerlendirildi. Bulgular: Çalışmaya dahil edilen 724 hastanın 317'sinin kolonoskopisin de patoloji mevcut idi. Bunlardan %57,4'ünde polip, %13,6'sında malignite, %8,2'sinde divertikül, %6,9'unda divertikül ve polip, %5,4'ünde ülseratif kolit, %3,8'inde crohn koliti, %4,1'inde anastomoz darlığı ve %0,6'sında lipom tespit edildi. Sol kolon lokalizasyonunda ve 50 yaş ve üstü olgularda prekanseröz ve kanserli polip prevalansının anlamlı derecede yüksek olduğu gözlendi. Polip tipi ile polip lokalizasyonu arasında anlamlı fark yoktu. Sonuç: Yaş, kolorektal poliplerin histopatolojisi için bağımsız bir risk faktörüdür. Bu nedenle, tarama programlarının yaygınlaştırılması gerektiğine inanıyoruz. Anahtar Kelimeler: Kolonoskopi, kolorektal polip, risk faktörü Aim: Colorectal cancer and its precursor lesions are quite common in developed countries. Data on the prevalence of lesions located in the right colon have been reported to range from 20.5 to 48.1% depending on the gender and advanced age. Today, many countries are conducting studies for disseminating the screening programmes in order to detect and treat polyps at an early stage. In this paper, we aimed to evaluate the relationship that exists between the patient's age and the polyp localisation with histopathology of colorectal polyp. Method: In our endoscopy unit, 789 patients underwent colonoscopy in the last two years. Among these, a total of 724 patients who met the criteria were included in the study group. The demography of the patients and histopathological data of the polyps were evaluated. Results: Of the 724 patients included in the study, 317 had at least one pathology detected by colonoscopy. Of these, 57.4% had polyp, 13.6% had malignancy, 8.2% had diverticula, 6.9% had both diverticula and polyp, 5.4% had ulcerative colitis, 3.8% had Crohn's colitis, 4.1% had anastomotic stricture, and 0.6% had lipoma. The prevalence of precancerous and cancerous polyps was observed to be significantly higher in the left colon localisation and among cases aged 50 and over. No significant difference was noticed between polyp type and polyp localisation. Conclusion: Age is an independent risk factor for histopathology of colorectal polyps. Therefore, we believe that screening programmes should be disseminated.
Molecular and Clinical Oncology, 2019
There is a lack of a national organized screening program for colorectal cancer in Greece, and asymptomatic detection is usually the result of individual decisions. The collection of epidemiologic endoscopic data from a population of interest would therefore provide valuable information for future treatment guidance, especially during periods of economic austerity. The current cross-sectional study included 380 asymptomatic, average risk individuals undergoing screening colonoscopy for the first time, during the period of one year in a tertiary public hospital in Athens. Descriptive and analytic epidemiologic data were analyzed. The prevalence of adenomas and advanced lesions were compared between the younger and older cohort, and a regression model was applied for risk evaluation. The mean age of participants was 63 years, and 53% were male. A significant proportion of patients presented with polyps (51.5%) and 25% of them had lesions in the proximal colon. The prevalence of adenomas and advanced adenomas was 29.5 and 11.8%, respectively. Similar high prevalence rates of lesions were identified in the cohort of individuals <50 years of age and the older cohort (>50 years of age). Regression models identified age, number and size of polyps as the major risk factors for the detection of adenomas. The increase of advanced lesions in the older and younger cohort requires confirmation by larger studies. Overall, the results of the present study indicate the requirement for a well-organized screening colonoscopy program starting from as early as 40 years of age. This program may confer an additional endoscopic burden with socioeconomic consequences in a country with limited health resources.
BJS open, 2023
Background: After colorectal polypectomy, 20-50 per cent of patients develop metachronous polyps and some have increased colorectal cancer risk. British Society of Gastroenterology (BSG) 2020 guidelines recommend surveillance colonoscopy for high-risk patients based on index pathology. The aim of this study was to evaluate metachronous lesion outcome using BSG 2020 criteria. Methods: A retrospective, multicentred study was conducted including patients who had polypectomy during screening colonoscopy (2009-2016) followed by surveillance. Demographics, index pathology, and BSG 2020 risk criteria were compared with regard to metachronous lesion pathology (non-advanced versus advanced lesions) and timing of detection (early versus late). Advanced lesions were defined as adenomas/serrated polyps greater than or equal to 10 mm, high-grade dysplasia, serrated polyps with dysplasia, or colorectal cancer, and late lesions those detected greater than 2 years after the index procedure. Results: Of 3090 eligible patients, 2643 were included. Among these, retrospective BSG 2020 application would have excluded 51.5 per cent from surveillance. After a median of 36 months, the advanced polyp/colorectal cancer rate in BSG 2020 high-risk patients was 16.3 versus 13.0 per cent in low-risk patients. Older age (P = 0.008) correlated with advanced metachronous lesions. Male sex, greater than five polyps, and BSG 2020 high-risk criteria correlated with non-advanced and advanced lesions (P < 0.001). Older age (P < 0.001), villous features (P = 0.006), advanced index polyp (P = 0.020), and greater than five polyps (P < 0.001) correlated with early metachronous lesions. Male sex and BSG 2020 high-risk criteria correlated with early and late lesions (P < 0.001). On multivariable regression, increased polyp number (odds ratio (OR) 1.15 (95 per cent c.i. 1.07 to 1.25); P < 0.001) and villous features (OR 1.49 (95 per cent c.i. 1.05 to 2.10); P = 0.025) independently correlated with early advanced lesions. The rate of non-advanced and advanced metachronous polyps was higher in BSG 2020 high-versus low-risk patients (44.4 versus 35.4 per cent for non-advanced and 15.7 versus 11.8 per cent for advanced; P < 0.001), but the colorectal cancer rate was similar (0.6 versus 1.2 per cent). However, when examining only lesions detected greater than 2 years after the index colonoscopy in high-versus low-risk patients, no significant differences were observed (P = 0.140). Conclusion: BSG 2020 criteria correlated with metachronous polyps, but did not differentiate advanced and non-advanced lesions and were not predictive of late lesions.
Age and site of Colonic Neoplastic Lesions: Implications of screening in South Asia
Pakistan Journal of Medical Sciences, 1969
Objective: To evaluate the Age of patients and the site of Colonic Neoplastic Lesions (CNL) and to determine the appropriate screening strategy for Colorectal Carcinoma (CRC) (sigmoidoscopy versus colonoscopy) in our population. Methods: This is a cross sectional study. Data of all patients more than 16 years of age who underwent full colonoscopic examination at the Aga Khan University hospital between January 2011 till December 2013 and were diagnosed to have CRC or advanced adenomas (defined as polyp more than 1 cm and/or having villous morphology on histology) was recorded. Lesions found distal to the splenic flexure were characterized as distal lesions and while lesions found between the splenic flexure and the cecum were characterized as proximal lesions. Results: During the study period colonic neoplastic lesions were found in 217 patients; 186 (85.7%) patients had CRC and 31(14.3%) patients had advanced adenomatous polyps. Mean age was 55.8±14 years and amongst them 72 (33.2%) patients were less than 50 years of age while 145 (66.8%) were more than 50 years. In 144 (66.4%) patients lesions were located in the distal colon, 65 (30%) had lesions in the proximal colon while in 8 (3.7%) patients the neoplastic lesions were found both in the proximal and distal colon. The predominant symptoms were bleeding per rectum in 39.6% of patients followed by weight loss in 31.8% of patients. Only 3 patients had familial syndromes with multiple polyps. When patients younger than 50 years of age were compared with patients more than 50 years there was no statistically significant difference between the site of neoplastic lesion as well as the presenting symptoms. (p value 0.85). Conclusion: Colonic Neoplastic Lesions presented at younger age in our study population and one third of the lesions were found in the right sided colon. Hence screening for CNLs should be implied at an earlier age preferably with colonoscopy. More population based data is required to further validate our results.
Colonoscopy in Colorectal-Cancer Screening for Detection of Advanced Neoplasia
The New England Journal of Medicine, 2006
Background Recommendations for colorectal-cancer screening are based solely on age and family history of cancer, not sex. Methods We performed a cross-sectional analysis of the data from a large colonoscopy-based screening program that included 50,148 participants who were 40 to 66 years of age. People 40 to 49 years of age were eligible only if they had a family history of cancer of any type. Of the 43,042 participants 50 to 66 years of age, 13.3% reported a family history of colorectal cancer, as did 66.3% of the 7106 participants who were 40 to 49 years of age. We defined advanced neoplasia as cancer or adenoma that was at least 10 mm in diameter, had high-grade dysplasia, or had villous or tubulovillous histologic characteristics, or any combination thereof. We used multivariate logistic regression to identify associations between participants' characteristics and advanced neoplasia in a primary (or derivation) data set, and we confirmed the associations in a secondary (or validation) data set. Results Advanced neoplasia was detected in 2553 (5.9%) participants 50 to 66 years of age and in 243 (3.4%) participants 40 to 49 years of age. The rate of complications during colonoscopy was 0.1%, and no participants died. In the validation set, a logistic-regression model showed that male sex was independently associated with advanced neoplasia (adjusted odds ratio, 1.73; 95% confidence interval, 1.52 to 1.98; P<0.001). In each age group (40 to 49 years, 50 to 54 years, 55 to 59 years, and 60 to 66 years), the number of persons who would have to undergo colorectal-cancer screening in order to detect one advanced neoplasia was significantly lower in men than in women (23 vs. 36, 17 vs. 28, 12 vs. 22, and 10 vs. 18, respectively). Conclusions We detected advanced neoplasia at a significantly higher rate in men than in women, which may warrant refinement of the screening recommendations for colorectal cancer.
Screening Colonoscopy in Very Elderly Patients
JAMA, 2006
Context Current guidelines do not include an upper age cutoff for colorectal cancer screening with colonoscopy. Although the prevalence of colonic neoplasia increases with age, life expectancy decreases. Thus, the benefit of screening colonoscopy in very elderly patients may be limited. Objective To compare estimated life-years saved with screening colonoscopy in very elderly vs younger persons. Design, Setting, and Participants Cross-sectional study conducted among 1244 asymptomatic individuals in 3 age groups (50-54 years [n = 1034], 75-79 years [n = 147], and Ն80 years [n = 63]) who underwent screening colonoscopy at a US teaching hospital and clinic. Main Outcome Measures Prevalence of various types of colon neoplasia; estimated gain in life expectancy, calculated as life expectancy − (life expectancy during polyp lag time ϩ life expectancy after colorectal cancer diagnosis); and comparison of mean gain in life expectancy across the 3 groups. Life expectancy and mortality data were derived from life tables, previous studies, and national databases. Results The prevalence of neoplasia was 13.8% in the 50-to 54-year-old group, 26.5% in the 75-to 79-year-old group, and 28.6% in the group aged 80 years or older. Despite higher prevalence of neoplasia in elderly patients, mean extension in life expectancy was much lower in the group aged 80 years or older than in the 50-to 54-year-old group (0.13 vs 0.85 years). In sensitivity analysis, with longer polyp lag times the mean extension in life expectancy decreased more in the elderly than in the younger patients; alternatively, if it was assumed that a smaller proportion of adenomas progress to colorectal cancer, the mean extension in life expectancy decreased less in the elderly than in the younger patients. Conclusions Even though prevalence of neoplasia increases with age, screening colonoscopy in very elderly persons (aged Ն80 years) results in only 15% of the expected gain in life expectancy in younger patients. Screening colonoscopy in very elderly patients should be performed only after careful consideration of potential benefits, risks, and patient preferences.